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Journal of Hand and Microsurgery

Ahmet Köse, Murat Topal, Recep Dinçer
No abstract text is available yet for this article.
April 2018: Journal of Hand and Microsurgery
Ji H Son, Christina Pindar, Hooman Soltanian
No abstract text is available yet for this article.
April 2018: Journal of Hand and Microsurgery
Alistair R M Macey, Roshin Thomas
The anatomy of the cords that form in Dupuytren's disease is complicated and a spiral cord is the most challenging variant to address. It displaces the neurovascular bundle toward or beyond the midline and closer to the skin. This article illustrates the surface anatomy of the neurovascular spiral to help surgeons identify this zone of danger that the authors term "the serpentine zone." Careful dissection in this zone will help avoid iatrogenic digital neurovascular injury.
April 2018: Journal of Hand and Microsurgery
Feiran Wu, Chye Yew Ng
We report an unusual anatomical variant of the palmar cutaneous branch (PCB) of the median nerve in a 46-year-old man presenting with recurrent carpal tunnel syndrome. At surgery, after neurolysis, the PCB was visualized arising at the level of the proximal margin of the transverse carpal ligament, mimicking the appearance of the recurrent motor branch. To date, there has been no description of this branch arising at this level. We aim to remind surgeons of this variation and highlight the importance of maintaining vigilance to avoid iatrogenic nerve injury...
April 2018: Journal of Hand and Microsurgery
Osman Kelahmetoglu, Mustafa Ekrem Gules, Nuh Mehmet Elmadag, Ethem Guneren, Selma Sonmez Ergun
Loss of the Achilles' tendon with overlying soft tissue and skin defects remains a complex reconstructive challenge. Herein we present our experience using a free composite anterolateral thigh (ALT) flap with vascularized fascia lata and a modified Lindholm's technique to repair the Achilles' tendon. A 37-year-old man suffered from tertiary Achilles' tendon rupture. For reconstruction, the free composite ALT flap with vascularized fascia lata was used to wrap Achilles' tendon. A modified Lindholm's technique was used to cover overlying soft tissue defects...
April 2018: Journal of Hand and Microsurgery
Debora Lana, Luigi Tarallo, Fabio Catani
Injuries of the triceps brachii muscle are a rare entity and mostly concern its distal tendon. These represent the least common of all muscle and tendons injuries. The most common reported causes are repeated strong physical efforts, a fall on an outstretched forearm when a sudden deceleration is put on contract triceps, or a direct trauma. High-dosed and prolonged corticosteroid therapies, repeated local steroid injections, chronic renal failure, diabetes, rheumatoid arthritis, hyperparathyroidism, and osteogenesis imperfecta are reported as systemic causes...
April 2018: Journal of Hand and Microsurgery
Anirban Chatterjee, Shamita Chatterjee
Subcutaneous and deep fungal infections in the hand are rare among children. These are usually found in immunocompromised adults or in persons engaged in soil handling activities, due to direct exposure, especially in the tropics. Delay in diagnosis is usual because pyogenic and other granulomatous infections are considered first. The authors present the case of a healthy, immunocompetent 2½-year-old child who presented with progressive swelling of the right hand mimicking a localized gigantism of the entire hand...
April 2018: Journal of Hand and Microsurgery
Ilias G Petrou, Claire Savioz-Leissing, Anne Gray
Pisiform dislocation is a rare wrist injury. The limited literature available describes this pathology in the form of case reports. An immediate closed reduction and immobilization is indicated for acute injury while there is a debate in the management of cases with delayed diagnosis or failed closed reduction. In this case, a 32-year-old, right-handed man visited the emergency department with pain at the ulnar side of his left wrist after a fall. The initial management involved immobilization, and the patient was referred to the authors' specialized clinic 10 days later because of persistence of important ulnar wrist pain...
April 2018: Journal of Hand and Microsurgery
Ravikiran Naalla, Moumita De, Rakesh Dawar, Shashank Chauhan, Maneesh Singhal
Purpose: Microvascular reconstruction is the standard of care for salvage of soft tissue defects in complex upper extremity due to their distinct advantages over the pedicled flaps. However, in the era of microsurgery, pedicled flaps have an acceptable significant role for reconstruction of complex soft tissue defects. The authors aim to demonstrate the versatility of pedicled thoracoumbilical flap (TUF) in selected clinical scenarios. Patients and Methods: Retrospective analysis of patients who underwent TUF for upper limb posttraumatic reconstruction was performed between January 2016 and October 2017...
April 2018: Journal of Hand and Microsurgery
Santosh J Mathen, Naveed N Nosrati, Gregory A Merrell
Purpose: In many procedures, both high case volumes and fellowship training have been shown to improve outcomes. One of the most common procedures performed by hand surgeons, the carpal tunnel release (CTR) is also performed by several other specialties without specialty training in a hand fellowship. This study analyzed the effect that hand fellowship training has on outcomes of CTRs. Materials and Methods: Using the American Board of Orthopedic Surgeons (ABOS) Part II candidates' case list submissions, a database was created for all open and endoscopic CTRs...
April 2018: Journal of Hand and Microsurgery
Andrew J Miller, Christopher M Jones, Dennis P Martin, Fred E Liss, Jack Abboudi, William H Kirkpatrick, Pedro K Beredjiklian
Background: Thumb metacarpal subsidence after trapeziectomy can affect clinical function over time. Methods for measuring subsidence after trapeziectomy have been described, and they rely on an intact thumb metacarpal or proximal phalanx for measurement. The authors evaluated the reliability and reproducibility of measuring the trapezial space ratio, using previously described methods. In addition, the authors evaluated a new method that measures trapezial space on a posteroanterior (PA) hand/wrist radiograph that does not rely on an intact thumb metacarpal or proximal phalanx for measurement, which can often be altered by degenerative changes or in cases in which metacarpophalangeal arthrodesis is performed during carpometacarpal (CMC) joint arthroplasty to correct excessive hyperextension...
April 2018: Journal of Hand and Microsurgery
Andrea Poggetti, Anna Maria Nucci, Thomas Giesen, Maurizio Calcagni, Stefano Marchetti, Michele Lisanti
Metacarpal fractures constitute 7.8% of the upper extremity fractures. The common treatments remain nonsurgical procedure, but high-demanding patients or unstable fractures require fixation with Kirschner wire (K-wires), plate, and screws. However, these approaches may cause scarring and adhesion with poor functional results. From 2014 to 2015, the authors used an intramedullary headless screw to treat 25 patients (24 men, 1 woman) with metacarpal bones fractures (20 V, 3 IV, 1 III, and 1 II). The fractures patterns were 23 fractures of distal third of metacarpal bone (16 oblique, 5 comminute configurations, and 2 transverse), 1 fracture of the base of the II metacarpal bone...
April 2018: Journal of Hand and Microsurgery
Nicholas E Crosby, Naveed N Nosrati, Greg Merrell, Hill Hasting
Purpose: Several studies have drawn a connection between cigarette smoking and cubital tunnel syndrome. One comparison article demonstrated worse outcomes in smokers treated with transmuscular transposition of the ulnar nerve. However, very little is known about the effect that smoking might have on patients who undergo ulnar nerve decompression at the elbow. The purpose of this study is to evaluate the effect of smoking preoperatively on outcomes in patients treated with ulnar nerve decompression...
April 2018: Journal of Hand and Microsurgery
Rachel Pedreira, Brian H Cho, Angela Geer, Ramon A DeJesus
Background: The difficulties in surgical treatment of pilon fractures of the finger include fragment reconstitution and posthealing stiffness. In adults, external fixation with traction and early active range of motion (AROM)/passive range of motion (PROM) during healing is considered necessary for avoiding joint stiffness and attaining realignment. The authors present a unique approach to pediatric pilon fractures that uses open reduction and multivector external fixation with delayed AROM/PROM...
April 2018: Journal of Hand and Microsurgery
Mark Tan, Sean Wei Loong Ho, Sreedharan Sechachalam
Background: Trauma resulting in severe comminution, bone loss, and articular involvement of the fingers is a challenging injury. Osteosynthesis of the digits is nonviable when there is an inability to restore a stable articular surface adequately. Acute arthrodesis of the proximal and distal interphalangeal joints may be an option in such scenarios. The aim of this study is to evaluate the role of finger joint arthrodesis in the setting of trauma, in terms of fusion rates and clinical outcomes...
April 2018: Journal of Hand and Microsurgery
Ahmadreza Afshar
No abstract text is available yet for this article.
December 2017: Journal of Hand and Microsurgery
Ahmadreza Afshar
No abstract text is available yet for this article.
December 2017: Journal of Hand and Microsurgery
Reid W Draeger, Donald K Bynum, J Megan M Patterson
Cable nerve grafting is the recommended surgical treatment for large peripheral nerve defects. Traditionally, this is performed by bridging a gap in the nerve with multiple autologous nerve cables, repairing the epineurium of each cable to the perineurium of a fascicle of the injured nerve that is similar in size to the graft. The authors present a new technique in which they used nerve-cutting guides to aid in the placement of fibrin glue to secure the sides of the cabled nerve graft together to facilitate handling of the cabled nerve graft and to expedite repair...
December 2017: Journal of Hand and Microsurgery
Michael V DeFazio, Kevin D Han, Ebrahim Paryavi
Successful replantation of distal digital segments necessitates the establishment of sufficient outflow to minimize congestion and progressive tissue necrosis. In cases where only arterial anastomosis is feasible, an artificial outlet must be provided to maintain physiological requirements until microvenous circulation regenerates. This can be accomplished using any number of "exsanguination techniques" designed to facilitate egress through ongoing passive blood loss. Although reportedly effective, these measures are imprecise and carry a substantial risk of infection, scarring, and/or uncontrolled hemorrhage...
December 2017: Journal of Hand and Microsurgery
Daniel P Carpenter, Reid W Draeger
We report a case of severe upper extremity complex regional pain syndrome type 1 (CRPS-1) and neurogenic edema that ultimately led to a medically necessary below-elbow amputation. The patient presented with a history of remote bilateral carpal tunnel release complicated by debilitating and recalcitrant bilateral CRPS-1. Following years of severe neurogenic edema of the left upper extremity, the patient had full-thickness skin sloughing on the dorsum of her hand due to massive edema. This subsequently led to maggot infestation of the soft tissues of the left hand ultimately necessitating amputation...
December 2017: Journal of Hand and Microsurgery
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